Culture and Ethnicity

1. The nurse recognizes that ethnicity differs from race in that ethnicity:

1.
Refers to subgroups within a race
2.
Is a unique factor within a cultural group
3.
Includes more than biological identification
4.
Is the set of conflicting values between races

ANS: 3

Ethnicity refers to a shared identity related to social and cultural heritage, such as values, language, geographical space, and racial characteristics. Race refers to biological attributes.

Subcultures refer to subgroups within a race. A variant cultural pattern is a unique factor within a cultural group. Ethnocentrism is the root of biases and prejudices comprising beliefs and attitudes associating negative permanent characteristics with people who are perceived to be different from the valued group.

DIF: A REF: 107 OBJ: Cognitive Level: Comprehension

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Psychosocial Integrity/Cultural Diversity

2. Within transcultural nursing, sensitivity to social organization is the recognition of the client’s:

1.
Language usage
2.
Status and expected role in the family
3.
Definition of health and health practices
4.
Psychological characteristics and coping mechanisms

ANS: 2

Cultural groups consist of units of social organization delineated by kinship, status hierarchy, and appropriate roles for their members. Sensitivity to social organization is the recognition of the client’s status and role in the family. Sensitivity to communication patterns would be the recognition of the client’s language usage. Culture is the framework used in defining social phenomena such as when a person is considered to be healthy or in need of intervention. The way an individual defines health and health practices needs to be understood by the nurse to best meet the needs of the client. Sensitivity to social organization is not met by recognizing the definition of health for an individual. Psychological characteristics and coping mechanisms may be expressed in a variety of ways across cultures. Sensitivity to social organization is not demonstrated by the recognition of psychological characteristics and coping mechanisms of a particular culture.

DIF: A REF: 116 OBJ: Cognitive Level: Comprehension

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Psychosocial Integrity/Cultural Diversity

3. Traditional Western medicine, in contrast to alternative therapy, uses:

1.
Acupuncture
2.
Herbal therapy
3.
Spiritual advising
4.
Medication administration

ANS: 4

Traditional Western medicine uses medication administration as a method of treatment.

Acupuncture is an alternative therapy often used in non-Western cultures such as the Chinese and Southeast Asians. Herbal therapy is an alternative therapy often used in non-Western cultures, but not in traditional Western medicine. Spiritual advising is not used in traditional Western medicine, but it may be seen in the African-American cultural group.

DIF: A REF: 110 OBJ: Cognitive Level: Comprehension

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Psychosocial Integrity/Cultural Diversity; Health Promotion and Maintenance/Health and Wellness

4. The nurse is completing an assessment of an Asian-American client. Recognizing that there are commonly seen problems in individuals from this background, the nurse observes for particular signs and symptoms of:

1.
Hypertension
2.
Tuberculosis
3.
Diabetes mellitus
4.
Lactose intolerance

ANS: 4

Lactose intolerance is frequently observed among Asians, Africans, and Hispanics. Hypertension is commonly seen in African Americans. Aboriginal Canadians descended from native North American Indians and living on reservations have a higher incidence of tuberculosis. Diabetes mellitus is commonly seen among Ute, Pima, and Papago Indians.

DIF: A REF: 116 OBJ: Cognitive Level: Knowledge

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Psychosocial Integrity/Cultural Diversity; Health Promotion and Maintenance/Health and Wellness

5. The nurse recognizes the following as an appropriate strategy for communicating with clients who are not fluent in English?

1.
Speaking in a louder tone of voice
2.
Incorporating hand gestures and pictures
3.
Responding to the client by his or her first name
4.
Interacting with an interpreter for all communication

ANS: 2

An appropriate strategy for communicating with clients who are not fluent in English is to incorporate hand gestures and pictures. Speaking in a louder tone of voice will not help the client understand the English language. Responding to the client by his or her first name may demonstrate a lack of respect. The nurse should introduce him or herself and then request the client to introduce himself or herself. An interpreter is not necessary for all communication. However, an interpreter must be used for communicating to the client information about his or her medical condition. It is not acceptable for family members to translate health care information, but they can assist with ongoing interaction during the client’s care.

DIF: A REF: 113 OBJ: Cognitive Level: Comprehension

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Psychosocial Integrity/Cultural Diversity

6. One aspect of a culture is invisible, or less observable, to others. A nurse wanting to develop an awareness of the practices of different cultures within that community would have which of the following as an example of this component?

1.
Wearing an amulet or charm
2.
Using prayer beads or candles
3.
Using cotton garments for clothing
4.
Believing in supernatural influences

ANS: 4

An example of an invisible (less observable) component of a culture is having a belief in supernatural influences. An example of a visible (easily seen) component of culture is the wearing of an amulet or charm. An example of a visible (easily seen) component of culture is using prayer beads or candles. Using cotton undergarments for clothing is a visible (easily seen) component of culture.

DIF: A REF: 107 OBJ: Cognitive Level: Comprehension

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Psychosocial Integrity/Cultural Diversity

7. From culture to culture time often takes on different meanings. In exploring the relationship of time to nursing interventions, the nurse should:

1.
Avoid using set times to do procedures, if possible
2.
Maintain the set times for treatments and inform the client of the schedule
3.
Maintain a flexible attitude when the client requests procedures to be done at specific times
4.
Encourage clients to set the times when they would like the nurse to perform nursing care activities.

ANS: 3

Because time has different meanings from one culture to another, the nurse should maintain a flexible attitude and not become emotionally upset when the client requests procedures to be done at different times. When making appointments and referrals, anticipated barriers to time adherence should be explored and managed with the client. For organizational purposes, nurses should seek clients’ input and together the nurse and client may set a time to do procedures. Maintaining set times for treatments and informing the client of the schedule do not take into consideration the client’s time orientation. Although the client’s input should be sought, it is not realistic to have clients set their own times for nursing care activities regardless of the schedule. Some procedures may be required more frequently than the client would set, or the nurse may be unable to meet the needs of several clients on the unit at the same time.

DIF: A REF: 118 OBJ: Cognitive Level: Comprehension

TOP: Nursing Process: Planning

MSC: NCLEX® test plan designation: Psychosocial Integrity/Cultural Diversity

8. The nurse recognizes that changes in demographics have an influence on health care delivery. One of the expectations in the United States by the year 2020 is:

1.
Growth of the European-American population
2.
Increases in the Hispanic and Latino populations
3.
Reduction of the African-American population by 50%
4.
Equal growth in the Hispanic-, Asian-, and African-American populations

ANS: 2

By 2020 the population of Hispanic and Latino populations is predicted to triple. Population projections beyond 2000 show Hispanics/Latinos, Asian-Americans, and African-Americans outpacing the growth of white, European-descended groups. The African-American group is projected to double by 2020. By 2020 the population of African Americans is predicted to double and that of Asian Americans and Hispanics/Latinos to triple.

DIF: A REF: 107 OBJ: Cognitive Level: Knowledge

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Psychosocial Integrity/Cultural Diversity; Health Promotion and Maintenance/Health and Wellness

9. While going through the process of acculturation a client will be:

1.
Identifying with 2 or more cultures
2.
Adapting to and adopting a new culture
3.
Showing favor to the dominant culture
4.
Socializing within their primary cultural group

ANS: 2

Acculturation is the process of adapting to and adopting a new culture. Biculturalism occurs when an individual identifies equally with two or more cultures. Assimilation occurs when an individual gives up his or her ethnic identity in favor of the dominant culture. Socialization into one’s primary culture as a child is known as enculturation.

DIF: A REF: 708 OBJ: Cognitive Level: Comprehension

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Psychosocial Integrity/Cultural Diversity

10. An example of a nurse imposing his/her own cultural beliefs on a client is evident in which of the following examples?

1.
Adaptation of the client’s room to accommodate family members
2.
Seeking information on gender-congruent care for an Egyptian client
3.
Administering less potent pain medication to an outpatient surgery client
4.
Encouraging family members to assist with the client’s feeding and hygiene care

ANS: 3

Holding back more potent pain medication for a client who had a minor procedure is an example of a cultural imposition of the nurse on a client. Adaptation of the client’s room to accommodate extra family members is not an example of cultural imposition on a client, but rather is meeting the client’s need by providing culturally congruent care. Seeking information on gender-congruent care for an Egyptian client is an example of the desire to provide culturally congruent care. Encouraging family to assist with the client’s care is not an example of cultural imposition on a client. Western culture tends to follow a pattern of caring that focuses on self-care and self-determination, whereas non-Western cultures typically have care provided by others.

DIF: A REF: 109 OBJ: Cognitive Level: Comprehension

TOP: Nursing Process: Implementation

MSC: NCLEX® test plan designation: Psychosocial Integrity/Cultural Diversity

11. Following a surgical procedure, an older Chinese woman refuses to perform the range of motion and breathing exercises requested, in addition is hesitant to complete her hygienic care and grooming. The nurse recognizes that this is most likely related to:

1.
Dependence on health care providers for care
2.
Reliance upon family members to assist with care
3.
Lack of personal motivation to participate in self-care
4.
Reluctance to cooperate with traditional Western medical treatment

ANS: 2

Non-Western cultures traditionally rely heavily on family members to provide care. Although it may be related to dependence on health care providers for care, it is not as likely because non-Western cultures depend on family members to assist with care. While it may be related to lack of personal motivation to participate in self-care, the client’s behavior is more likely a result of her cultural background rather than a lack of motivation. While the client’s behavior may be a result of reluctance to cooperate with Western medical treatments, it is more likely indicative of her cultural dependence on family members.

DIF: C REF: 110 OBJ: Cognitive Level: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Psychosocial Integrity/Cultural Diversity; Health Promotion and Maintenance/Health and Wellness

12. When faced with a scenario where it is believed that a client from another cultural background is using herbal remedies along with the prescribed medication to treat her arthritis. The nurse’s first action should be to:

1.
Educate the client concerning the danger of taking herbs and the prescribed medication
2.
Inquire of the client as to the reason for using herbal remedies along with the prescribed medication
3.
Ask the client to identify what herbal remedies are being used along with the prescribed medications
4.
Alert the physician to the client’s use of herbal remedies in addition to the prescribed medications

ANS: 3

Rather than first dismissing the practice as dangerous and incompatible with Western medicine, practitioners need to investigate further whether the practice needs changing. Although educating the client may be appropriate, this cannot be determined until the herb has been identified and it is determined to be harmful in this situation. Asking the client why additional remedies are being used may make the client feel defensive. The nurse needs to first determine what herbs are being used. While alerting the physician is appropriate, it is not the first action to be taken by the nurse. The nurse should initially determine what herbs are being used.

DIF: C REF: 110 OBJ: Cognitive Level: Analysis

TOP: Nursing Process: Implementation

MSC: NCLEX® test plan designation: Psychosocial Integrity/Cultural Diversity; Health Promotion and Maintenance/Health and Wellness

13. Being cared for by a nurse of the opposite gender would be an especially important issue for women from which of the following cultures?

1.
Afghan
2.
Filipino
3.
Native American
4.
African American

ANS: 1

Modesty is a strong value among Afghan and Arab women.

Modesty is not an especially important issue for Filipino women.

Modesty is not an especially important issue for Native American women.

Modesty is not an especially important issue for African American women.

DIF: A REF: 109 OBJ: Cognitive Level: Knowledge

TOP: Nursing Process: Planning

MSC: NCLEX test plan designation: Psychosocial Integrity/Cultural Diversity; Health Promotion and Maintenance/Health and Wellness

14. An example of a culture where a male relative will regularly decline to observe the birth process is:

1.
Pakistani
2.
Hispanic
3.
Korean
4.
Japanese

ANS: 1

Religious beliefs may prohibit the presence of males, including husbands, in the delivery room. This may be observed among devout Muslims, Hindus, and Orthodox Jews. Hispanic men typically do not have religious or cultural beliefs that would prohibit them from the delivery room. Korean men typically do not have religious or cultural beliefs that would prohibit them from the delivery room. Asian men typically do not have religious or cultural beliefs that would prohibit them from the delivery room.

DIF: A REF: 111 OBJ: Cognitive Level: Knowledge

TOP: Nursing Process: Planning

MSC: NCLEX® test plan designation: Psychosocial Integrity/Cultural Diversity; Health Promotion and Maintenance/Health and Wellness

15. The nurse observes a religious charm hanging from the wrist of a client being prepared for surgery. The nurse’s best initial approach is to:

1.
Remove the religious charm
2.
Securely tape the charm in place
3.
Ask the client to leave the charm with family members
4.
Clarify whether the charm may remain in place during the procedure

ANS: 4

The nurse should first determine if it is permissible for the item to remain in place during the procedure. Removing the bracelet may create unnecessary stress for the client. Initially the nurse should determine if removal is necessary. Taping the bracelet in place may be appropriate after the nurse determines that the item may remain in place during the procedure. Asking the client to remove the item may create unnecessary stress for the client. Initially the nurse should determine if removal is necessary.

DIF: B REF: 109 OBJ: Cognitive Level: Application

TOP: Nursing Process: Implementation

MSC: NCLEX® test plan designation: Psychosocial Integrity/Cultural Diversity; Health Promotion and Maintenance/Health and Wellness

16. The nurse recognizes that the family of a deceased Buddhist client will:

1.
Bury before sundown
2.
Decline viewing the body
3.
Not move the body until it is cold
4.
Select cremation rather than burial

ANS: 3

Some Buddhists may refuse to move the dead body after death because of their belief that the spirit of the dead takes some time to leave the body. They define death as the absence of consciousness and loss of body warmth. Among Orthodox Jews, the body is generally buried before sundown. Some Asian Indians regard seeing the deceased as adding to the suffering of the family. Hindus and Buddhists believe that the soul lives on and the dead body without the soul is but an empty shell, and therefore may not want to see the body. Muslims prefer burial rather than cremation.

DIF: A REF: 112-113 OBJ: Cognitive Level: Knowledge

TOP: Nursing Process: Planning

MSC: NCLEX® test plan designation: Psychosocial Integrity/Cultural Diversity

17. A nurse that has the knowledge of the biocultural history of clients and aware that individuals with a greater potential for and incidence of hypertension are:

1.
Asians
2.
Hispanics
3.
Native Americans
4.
African Americans

ANS: 4

Malignant hypertension is found more frequently in African Americans. Lactose intolerance is frequently observed among Asians. Hispanics have a higher incidence of lactose intolerance. Native Americans have a higher incidence of tuberculosis and diabetes mellitus.

DIF: A REF: 117 OBJ: Cognitive Level: Knowledge

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Psychosocial Integrity/Cultural Diversity; Health Promotion and Maintenance/Health and Wellness

18. There are cultural context of health and illness differences in comparing Western versus non-Western cultures. The nurse is aware that in Western culture the overall treatment is:

1.
Herbal
2.
Holistic
3.
Naturalistic
4.
Specialty-specific

ANS: 4

The overall treatment in Western culture is specialty-specific. The treatment in some non-Western cultures is herbal. The treatment in non-Western cultures is holistic in nature. Some non-Western cultures use a naturalistic approach for the method of diagnosis.

DIF: A REF: 109 OBJ: Cognitive Level: Knowledge

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Psychosocial Integrity/Cultural Diversity; Health Promotion and Maintenance/Health and Wellness

19. Regarding a client who is an Orthodox Jew and maintains a Kosher diet, the nurse will make sure that the client’s menu does not include:

1.
Beef
2.
Eggs
3.
Milk
4.
Shellfish

ANS: 4

Jewish clients who follow a Kosher diet will avoid meat from carnivores, pork products, and fish without scales or fins. Therefore shellfish should not be included in the menu of a client who is an Orthodox Jew and maintains a Kosher diet. Beef may be included in a Kosher diet. Eggs may be included in a Kosher diet. Milk may be included in a Kosher diet.

DIF: A REF: 117 OBJ: Cognitive Level: Knowledge

TOP: Nursing Process: Planning

MSC: NCLEX® test plan designation: Psychosocial Integrity/Cultural Diversity; Health Promotion and Maintenance/Health and Wellness

20. For a client who is a Buddhist and maintains a traditional diet, the nurse will make sure that a sufficient quantity of which of the following is included in the menu?

1.
Beef
2.
Milk
3.
Fish
4.
Vegetables

ANS: 4

Many Buddhists are vegetarians. The nurse should ensure that a sufficient quantity of vegetables is included in the menu when caring for a Buddhist who maintains a traditional diet. Beef is not a traditional component of a Buddhist’s diet. A sufficient quantity of milk is not necessary for the traditional Buddhist’s diet. A sufficient quantity of fish is not necessary for the traditional Buddhist’s diet.

DIF: A REF: 117 OBJ: Cognitive Level: Knowledge

TOP: Nursing Process: Planning

MSC: NCLEX® test plan designation: Psychosocial Integrity/Cultural Diversity; Health Promotion and Maintenance/Health and Wellness

21. Which of the following factors has the greatest impact on health care available to non-Hispanic white minority groups in the United Sates?

1.
Significant language barriers
2.
Inappropriately high poverty rates
3.
Genetically based disease processes
4.
Mistrust of Western medical practices

ANS: 2

Racial and ethnic minorities are more likely than non-Hispanic whites to be poor or near poor. In addition, Hispanics, African Americans, and some Asian subgroups are less likely than non-Hispanic whites to have a high school education. In general, racial and ethnic minorities often experience poorer access to care and lower quality of preventive, primary, and specialty care. While language barriers may have an influence on the amount and type of health care services available to and sought out by minority groups, it is poverty that has the greatest negative influence. While genetically based disease processes may have an influence on the amount and type of health care services available to and sought out by minority groups, it is poverty that has the greatest negative influence. Although mistrust of Western medical practices may have an influence on the amount and type of health care services available to and sought out by minority groups, it is poverty that has the greatest negative influence.

DIF: C REF: 107 OBJ: Cognitive Level: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Psychosocial Integrity/Cultural Diversity; Health Promotion and Maintenance/Health and Wellness

22. The nurse who is attempting to practice in a culturally sensitive manner must first realize that recognition of the visible signs of a client’s culture:

1.
Is essential to the establishment of a nurse-client relationship
2.
Provides the basis for a sense of trust between client and nurse
3.
Does not ensure understanding of the underlying cultural beliefs
4.
Has little impact on the nurse’s ability to provide therapeutic care

ANS: 3

Culture has both visible (easily seen) and invisible (less observable) components. Nurses cannot appreciate the meanings and beliefs associated with these artifacts without further assessment.

Recognition of visible signs of a client’s culture will assist in the formation of a therapeutic nurse-client relationship because it conveys the nurse’s interest in the client as a person; it is not essential to the relationship process. Recognition of visible signs of a client’s culture will assist in the formation of trust (a component of a therapeutic nurse-client relationship) because it conveys the nurse’s interest in the client as a person; it is not essential to the trust-establishing process. Recognition of visible signs of a client’s culture will assist in the formation of a therapeutic nurse-client relationship, which is vital to the nurse’s ability to provide therapeutic care because it conveys the nurse’s interest in the client as a person.

DIF: C REF: 107 OBJ: Cognitive Level: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Psychosocial Integrity/Cultural Diversity; Health Promotion and Maintenance/Health and Wellness

23. Which of the following nursing interventions shows the greatest degree of culturally competent nursing care for a Muslim female client?

1.
Notifying the chaplain of the client’s religious preference
2.
Notifying staff that the client’s bath will be done by her sister
3.
Drawing the curtains around the client’s bed during prayer time
4.
Facilitating a dietary consult to meet the client’s nutritional concerns

ANS: 2

Cultural competence is the process of acquiring specific knowledge, skills, and attitudes that ensure delivery of culturally congruent care. By arranging for the family to assume responsibility for the client’s hygiene, the nurse has shown a specific knowledge of the client’s needs and acted upon that need. The other options are not as specific or as directly related to nursing care as notifying the staff that the client’s bath will be done by her sister.

DIF: C REF: 109 OBJ: Cognitive Level: Analysis

TOP: Nursing Process: Planning

MSC: NCLEX® test plan designation: Psychosocial Integrity/Cultural Diversity; Health Promotion and Maintenance/Health and Wellness

24. A nursing care assistant fails to report in a timely manner a request for pain medication from an African-American male client who is recovering from a stab wound. The nurse’s initial action is to evaluate the care assistant’s:

1.
Feelings regarding this particular client
2.
Need for administrative disciplinary action
3.
Understanding of the need for prompt reporting
4.
Employment files for documentation of similar behavior

ANS: 1

Personal bias and prejudices when acted upon may interfere with the delivery of appropriate, effective nursing care. While all the options are appropriate, the nurse’s initial action is to determine the cause of the care assistant’s negligent behavior. Although all the options are appropriate, the nurse’s initial action is to determine the cause of the care assistant’s negligent behavior.

DIF: C REF: 109 OBJ: Cognitive Level: Analysis

TOP: Nursing Process: Evaluation

MSC: NCLEX® test plan designation: Psychosocial Integrity/Cultural Diversity; Health Promotion and Maintenance/Health and Wellness

25. An Arab woman arrives in the emergency department reporting vaginal bleeding. It is determined that the client is 5 months pregnant with her second child and has had no prenatal care. The nurse realizes that the most likely reason for this lack of health care is that the client:

1.
Cannot afford to seek health care
2.
Views pregnancy as a normal life event
3.
Typically relies on same-culture healers
4.
Lacks an understanding of available services

ANS: 2

Culture is the context in which groups of people interpret and define their experiences relevant to life transitions. This includes events such as birth, illness, and dying. It is the system of meanings by which people make sense of their experiences. Culture is how others define social phenomena such as when a person is healthy or requires intervention. Traditionally, in Arab culture, pregnancy is not a medical condition but rather a normal life transition; hence, a pregnant woman does not always go to a doctor unless she has a problem. While the other options may have been a factor, the most likely cause is that the Arab culture views pregnancy as a normal life event and care is sought only when a perceived problem exists.

DIF: C REF: 109 OBJ: Cognitive Level: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Psychosocial Integrity/Cultural Diversity; Health Promotion and Maintenance/Health and Wellness

26. An Asian-American client will accept hygiene care from only family members. The cultural origin of this behavior is most likely:

1.
Valued privacy
2.
Female modesty
3.
Interdependency
4.
Mistrust of strangers

ANS: 3

In collectivistic cultures that value group reliance and interdependence, such as traditional Asians, Hispanics, and Africans, caring behaviors require actively providing physical and psychosocial support for family or community members. While the other options may be individualized factors, culturally the most likely origin is that of group reliance and interdependency of the Asian culture.

DIF: C REF: 110 OBJ: Cognitive Level: Analysis

TOP: Nursing Process: Planning

MSC: NCLEX® test plan designation: Psychosocial Integrity/Cultural Diversity; Health Promotion and Maintenance/Health and Wellness

27. An older Chinese client experienced a stroke that left him with right-sided weakness and now refuses to participate in physical therapy until his son is present. The nurse should initially interpret this behavior as:

1.
A sign of post-stroke depression
2.
An illustration of cultural collectivism
3.
A response to the therapy-induced pain
4.
An example of a healthy father-son relationship

ANS: 2

In collectivistic cultures that value group reliance and interdependence, such as traditional Asians, Hispanics, and Africans, caring behaviors require actively providing physical and psychosocial support for family or community members. The other options may be true; however, the more likely interpretation is the client’s cultural inclination toward group reliance and family support systems.

DIF: C REF: 110 OBJ: Cognitive Level: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Psychosocial Integrity/Cultural Diversity; Health Promotion and Maintenance/Health and Wellness

28. While assessing an older Vietnamese client, the nurse notes several oval-shaped reddened areas on her back and arms. The client’s daughter explains them to be the result of a traditional healing practice called “cupping.” The nurse’s immediate reaction should be to:

1.
Report the finding to the authorities to rule out physical abuse
2.
Ask the daughter to explain the practice in detail
3.
Notify the client’s health care provider to see if treatment is necessary
4.
Document the assessment findings in the nursing notes

ANS: 2

Many Southeast-Asian cultures practice folk remedies such as coining, cupping, pinching, and burning to relieve aches and pains and remove bad wind or noxious elements that cause illness. These remedies leave peculiar visible markings on the skin in the form of ecchymosis, superficial burns, strap marks, or local tenderness. Cultural ignorance causes a practitioner to call authorities for suspicion of abuse. Nurses need to investigate to determine the details of the practice in order to decide whether the practice needs to be changed. Consultation and collaboration with herbalists and other naturalistic practitioners will prevent unnecessary distress for the client. While reporting the finding to authorities should not be dismissed, the nurse should first discuss the practice with the daughter to learn more of the details regarding the practice. The client’s health care provider should be notified, however, the nurse’s assessment of the areas as “reddened areas” suggests that other options may have priority. Documentation of the assessment findings is certainly appropriate and is a nursing responsibility, but acquiring an explanation from the daughter who is present would have priority.

DIF: C REF: 110 OBJ: Cognitive Level: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Psychosocial Integrity/Cultural Diversity; Health Promotion and Maintenance/Health and Wellness

29. The nurse, caring for a comatose Muslim client who is dying, realizes that from a cultural standpoint, the most therapeutic intervention is to:

1.
Facilitate the client’s peaceful, pain-controlled death
2.
Become familiar with Muslim death and dying traditions
3.
Approach the family to identify and discuss any needs that exist
4.
Arrange for a private room so the family can grieve traditionally

ANS: 3

Be aware of religious and cultural preferences when helping clients and families prepare for death. Facilitating the client’s peaceful, pain-controlled death is an appropriate intervention; it is not necessarily culturally oriented because nursing strives to facilitate a peaceful, pain-free death for all clients. Becoming familiar with cultural tradition is therapeutic and would have priority if the family were not present to be questioned directly regarding their needs. Arranging for a private room may be a therapeutic intervention because most cultures would prefer some degree of privacy when attending to the death of a loved one, but since the family is present the priority intervention is the one that identifies their needs.

DIF: C REF: 112-113 OBJ: Cognitive Level: Analysis

TOP: Nursing Process: Planning

MSC: NCLEX® test plan designation: Psychosocial Integrity/Cultural Diversity; Health Promotion and Maintenance/Health and Wellness

30. A Hispanic client is diagnosed with inoperable brain cancer. The client’s wife insists that any discussion about treatment options be postponed until all local family members are present. The nurse correctly views this as:

1.
The family’s attempt to facilitate a “good death’’ for the client
2.
An invasion of the client’s right of confidentiality by the family members
3.
Appropriate because the cancer may have affected his decision-making abilities
4.
A cultural tradition that relieves the ill family member of the burden of decision making

ANS: 4

In some cultures, the group assumes decision making for a family member in these situations and is trusted to make the right decision for the individual. Indeed, some groups such as African Americans, Asian Americans, and Hispanics expect their family to make decisions for them, and family members prefer to protect the individual from unnecessary suffering by knowing the reality of imminent death. These cultures value group interdependence and view individual autonomy as an unnecessary burden for a loved one who is ill (Pacquiao, 2002, 2003a). The means by which the family provides a “good death” is first established through the process of group decision making. It may appear that the client’s confidentiality is being invaded by a member of the Western nursing profession; it is a cultural norm for members of many Hispanic families. Although cancer may affect the client’s abilities to make decisions, the origin of this behavior is more likely the cultural tradition of group decision making among Hispanics.

DIF: C REF: 111 OBJ: Cognitive Level: Analysis

TOP: Nursing Process: Evaluation

MSC: NCLEX® test plan designation: Psychosocial Integrity/Cultural Diversity; Health Promotion and Maintenance/Health and Wellness

31. The nurse realizes that the primary goal of a cultural assessment is to:

1.
Minimize client distress resulting from unmet cultural expectations
2.
Provide care that is in concert with the client’s cultural expectations
3.
Identify cultural beliefs and traditions that are important to the client
4.
Blend Western nursing practice with the client’s cultural expectations

ANS: 2

The goal of cultural assessment is to gather significant information from the client that will enable the nurse to implement culturally congruent care. Minimizing distress is an achieved outcome when the goal of culturally congruent care is met. Identifying beliefs and traditions is an assessment goal that helps identify the criteria for individualized, culturally congruent care.

Blending Western nursing practice with cultural expectations will result in individualized, culturally congruent care.

DIF: C REF: 108 OBJ: Cognitive Level: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Psychosocial Integrity/Cultural Diversity; Health Promotion and Maintenance/Health and Wellness

32. The nurse caring for members of the Hispanic community recognizes which of the following situations as the best reflection of the culture’s view of family caring?

1.
A husband calling each evening to tell his wife goodnight
2.
Family members taking turns staying with the client at night
3.
The daughter bringing her father’s favorite soup to the hospital
4.
The eldest son sending a huge floral arrangement to the hospital

ANS: 2

In collectivistic groups such as the Hispanic culture, the physical presence of loved ones with the client demonstrates caring. While the other options show caring, it is not the best option reflecting the Hispanic culture.

DIF: C REF: 110 OBJ: Cognitive Level: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Psychosocial Integrity/Cultural Diversity; Health Promotion and Maintenance/Health and Wellness

33. A nurse caring for the Arab community observes a client crying. The woman was recently informed that her radiation treatments may affect her ability to become pregnant. The nurse recognizes that the client is most likely reacting to a cultural attitude regarding:

1.
The importance of children to an Arab family
2.
The Arab view that infertility is grounds for divorce
3.
Infertility is a punishment for unholy living
4.
The loss of status among other married Arab women

ANS: 2

Infertility in a woman is considered grounds for divorce and rejection among Arabs. Although infertility is grounds for divorce in Arab cultures, it is not the best option for this question.

Infertility as a punishment for unholy living may not be a generally accepted view, it is not the best option for this question. While the loss of status among other married Arab women may be true, it is not the best option for this question.

DIF: C REF: 111 OBJ: Cognitive Level: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Psychosocial Integrity/Cultural Diversity; Health Promotion and Maintenance/Health and Wellness

34. The primary problem with using English-speaking children of immigrant families as interpreters is that:

1.
The adults may resent their dependence upon the child
2.
The subjects discussed may be too disturbing to the child
3.
Children can be easily distracted, thus making them unreliable translators
4.
There are concerns about the child’s ability to convey important information

ANS: 1

Assuming that children are ideal interpreters for their parents may in fact be an insult to the authority of the elder who has to take directions from a child. Although the other options may be true, it is not the primary reason for the concerns regarding using children as interpreters.

DIF: C REF: 115 OBJ: Cognitive Level: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Psychosocial Integrity/Cultural Diversity; Health Promotion and Maintenance/Health and Wellness

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